Purpose: Due to chronic toxicity, tacrolimus-sparing is an important issue in kidney transplant recipients (KTRs). Several studies have shown that bisphosphonate use is associated with favorable graft outcomes in KTRs. We investigated whether the association between tacrolimus trough levels (TTLs) and graft outcomes differed according to bisphosphonate use in KTRs. Materials and Methods: We conducted a retrospective study encompassing 1441 KTRs who were administered tacrolimus-based immunosuppressants. The primary exposure was a time-dependent cross-product of TTLs (low TTLs vs. normal-high TTLs with a reference of 6 ng/mL) and bisphosphonate use. Two primary outcomes were evaluated: overall graft loss (death or conversion to kidney replacement) and an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 . Results: During the median follow-up of 6.1 (3.4–9.7) years, overall graft loss occurred in 157 (10.9%) patients. Cox regression revealed that normal-high TTLs without bisphosphonate use were associated with a reduced risk of overall graft loss [adjusted hazard ratio (aHR), 0.65; 95% confidence interval (CI), 0.45–0.95] compared to low TTLs without bisphosphonate use. The use of bisphosphonate in conjunction with normal-high TTLs correlated with an even lower risk of overall graft loss (aHR, 0.25; 95% CI, 0.08–0.80) compared with low TTLs without bisphosphonate use. In patients with low TTLs, bisphosphonate use was associated with a reduced risk of overall graft loss compared with non-use (aHR, 0.20; 95% CI, 0.09–0.43). Similar trends were observed in the eGFR outcome. Conclusion The use of bisphosphonate was associated with favorable graft outcomes, even with low TTLs. Incorporating bisphosphonate into a conventional immunosuppressant regimen may potentially reduce tacrolimus requirement.

Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is made clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder. Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the Population, Intervention, Comparator, and Outcome (PICO) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term functional disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and rather than as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilation with steroid injections can also be beneficial. Conclusion These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition.The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and anti resorptive agents in sequential therapy approaches. Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to anti resorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for in dividuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. Conclusions This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

Objective: This study aimed to develop a Korean version of the Nonsuicidal Self-injury Inventory (K-NSSI) through the Deliberate Self-harm Inventory (DSHI) developed by Gratz for the Korean context and confirm its reliability and validity for clinical application. Methods: A total of 188 participants were analyzed utilizing the DSHI, the Korean version of the Self-harm Inventory, the Personality Assessment Inventory-Borderline Features (PAI-BOR), and the DSM-5 Level-2-Depression scale (Level-2-Dep). Cronbach’s α assessed their reliability, while frequency analysis examined the items of the K-NSSI scales.Validity of the K-NSSI was confirmed through correlation analyses between K-NSSI (tendency for and frequency of nonsuicidal self-injury [NSSI] behavior) and SHI, PAI-BOR total scale, four subscales of PAI-BOR, and Level-2-Dep scale. Polyserial correlations analyzed the correlation between the presence of NSSI behavior and other scales.Confirmatory factor analysis and structural equation modeling explored the relationship between borderline personality features and self-harm. Results: Cronbach’s α was 0.71, indicating an “acceptable” level of reliability. Statistically significant correlations were observed between the presence of NSSI behavior and the total scores of SHI and PAI-BOR, and the four subscales of PAI-BOR. The frequency of NSSI showed statistically significant correlations with the total score of SHI and PAI-BOR, and its four subscales. Notably, 13.8% of participants reported engaging in self-harm behaviors, 26.9% reported a single occurrence, and 73.1% reported two or more instances. Structural equation modeling demonstrated that self-harm adequately predicted borderline personality traits. Conclusion This study successfully validated the adaptation of DSHI into K-NSSI. The K-NSSI can facilitate interventions for self-harm incidents.

Objective: This study aimed to develop a Korean version of the Nonsuicidal Self-injury Inventory (K-NSSI) through the Deliberate Self-harm Inventory (DSHI) developed by Gratz for the Korean context and confirm its reliability and validity for clinical application. Methods: A total of 188 participants were analyzed utilizing the DSHI, the Korean version of the Self-harm Inventory, the Personality Assessment Inventory-Borderline Features (PAI-BOR), and the DSM-5 Level-2-Depression scale (Level-2-Dep). Cronbach’s α assessed their reliability, while frequency analysis examined the items of the K-NSSI scales.Validity of the K-NSSI was confirmed through correlation analyses between K-NSSI (tendency for and frequency of nonsuicidal self-injury [NSSI] behavior) and SHI, PAI-BOR total scale, four subscales of PAI-BOR, and Level-2-Dep scale. Polyserial correlations analyzed the correlation between the presence of NSSI behavior and other scales.Confirmatory factor analysis and structural equation modeling explored the relationship between borderline personality features and self-harm. Results: Cronbach’s α was 0.71, indicating an “acceptable” level of reliability. Statistically significant correlations were observed between the presence of NSSI behavior and the total scores of SHI and PAI-BOR, and the four subscales of PAI-BOR. The frequency of NSSI showed statistically significant correlations with the total score of SHI and PAI-BOR, and its four subscales. Notably, 13.8% of participants reported engaging in self-harm behaviors, 26.9% reported a single occurrence, and 73.1% reported two or more instances. Structural equation modeling demonstrated that self-harm adequately predicted borderline personality traits. Conclusion This study successfully validated the adaptation of DSHI into K-NSSI. The K-NSSI can facilitate interventions for self-harm incidents.

Purpose: Perspectives of radiation oncologists on oligometastatic disease was investigated using multi-layered survey. Materials and Methods: Online survey on the oligometastatic disease was distributed to the board-certified regular members of the Korean Society for Radiation Oncology. The questionnaire consisted of four domains: five questions on demographics; five on the definition of oligometastatic disease; four on the role of local therapy; and three on the oligometastatic disease classification, respectively. Results: A total of 135 radiation oncologists participated in the survey. The median length of practice after board certification was 22.5 years (range, 1 to 44 years), and the vast majority (94.1%) answered affirmatively to the clinical experience in oligometastatic disease management. Nearly two-thirds of the respondents considered the number of involved organs as an independent factor in defining oligometastasis. Most frequently perceived upper limit on the numerical definition of oligometastasis was 5 (64.2%), followed by 3 (26.0%), respectively. Peritoneal and brain metastasis were nominated as the sites to be excluded from oligometastastic disease by 56.3% and 12.6% of the participants, respectively. Vast majority (82.1%) agreed on the role of local treatment in the management of oligometastatic disease. Majority (72%) of the participants acknowledged the European Society for Radiotherapy and Oncology (ESTRO)–European Organisation for Research and Treatment of Cancer (EORTC) classification of oligometastatic disease, however, only 43.3% answered that they applied this classification in their clinical practice. Underlying reasons against the clinical use were ‘too complicated’ (66.0%), followed by ‘insufficient supporting evidence’ (30.0%), respectively. Conclusion While most radiation oncologists supported the role of local therapy in oligometastatic disease, there were several inconsistencies in defining and categorizing oligometastatic disease. Continued education and training on oligometastatic disease would be also required to build consensus among participating caregivers.

OBJECTIVES: The escalating burden of cardiovascular disease (CVD) is a critical public health issue worldwide. CVD, especially acute myocardial infarction (AMI) and stroke, is the leading contributor to morbidity and mortality in Korea. We aimed to develop algorithms for identifying AMI and stroke events from the National Health Insurance Service (NHIS) database and validate these algorithms through medical record review. METHODS: We first established a concept and definition of “hospitalization episode,” taking into account the unique features of health claims-based NHIS database. We then developed first and recurrent event identification algorithms, separately for AMI and stroke, to determine whether each hospitalization episode represents a true incident case of AMI or stroke. Finally, we assessed our algorithms’ accuracy by calculating their positive predictive values (PPVs) based on medical records of algorithm- identified events. RESULTS: We developed identification algorithms for both AMI and stroke. To validate them, we conducted retrospective review of medical records for 3,140 algorithm-identified events (1,399 AMI and 1,741 stroke events) across 24 hospitals throughout Korea. The overall PPVs for the first and recurrent AMI events were around 92% and 78%, respectively, while those for the first and recurrent stroke events were around 88% and 81%, respectively. CONCLUSIONS We successfully developed algorithms for identifying AMI and stroke events. The algorithms demonstrated high accuracy, with PPVs of approximately 90% for first events and 80% for recurrent events. These findings indicate that our algorithms hold promise as an instrumental tool for the consistent and reliable production of national CVD statistics in Korea.

Objective: This study aimed to develop a Korean version of the Nonsuicidal Self-injury Inventory (K-NSSI) through the Deliberate Self-harm Inventory (DSHI) developed by Gratz for the Korean context and confirm its reliability and validity for clinical application. Methods: A total of 188 participants were analyzed utilizing the DSHI, the Korean version of the Self-harm Inventory, the Personality Assessment Inventory-Borderline Features (PAI-BOR), and the DSM-5 Level-2-Depression scale (Level-2-Dep). Cronbach’s α assessed their reliability, while frequency analysis examined the items of the K-NSSI scales.Validity of the K-NSSI was confirmed through correlation analyses between K-NSSI (tendency for and frequency of nonsuicidal self-injury [NSSI] behavior) and SHI, PAI-BOR total scale, four subscales of PAI-BOR, and Level-2-Dep scale. Polyserial correlations analyzed the correlation between the presence of NSSI behavior and other scales.Confirmatory factor analysis and structural equation modeling explored the relationship between borderline personality features and self-harm. Results: Cronbach’s α was 0.71, indicating an “acceptable” level of reliability. Statistically significant correlations were observed between the presence of NSSI behavior and the total scores of SHI and PAI-BOR, and the four subscales of PAI-BOR. The frequency of NSSI showed statistically significant correlations with the total score of SHI and PAI-BOR, and its four subscales. Notably, 13.8% of participants reported engaging in self-harm behaviors, 26.9% reported a single occurrence, and 73.1% reported two or more instances. Structural equation modeling demonstrated that self-harm adequately predicted borderline personality traits. Conclusion This study successfully validated the adaptation of DSHI into K-NSSI. The K-NSSI can facilitate interventions for self-harm incidents.

Objective: This study aimed to develop a Korean version of the Nonsuicidal Self-injury Inventory (K-NSSI) through the Deliberate Self-harm Inventory (DSHI) developed by Gratz for the Korean context and confirm its reliability and validity for clinical application. Methods: A total of 188 participants were analyzed utilizing the DSHI, the Korean version of the Self-harm Inventory, the Personality Assessment Inventory-Borderline Features (PAI-BOR), and the DSM-5 Level-2-Depression scale (Level-2-Dep). Cronbach’s α assessed their reliability, while frequency analysis examined the items of the K-NSSI scales.Validity of the K-NSSI was confirmed through correlation analyses between K-NSSI (tendency for and frequency of nonsuicidal self-injury [NSSI] behavior) and SHI, PAI-BOR total scale, four subscales of PAI-BOR, and Level-2-Dep scale. Polyserial correlations analyzed the correlation between the presence of NSSI behavior and other scales.Confirmatory factor analysis and structural equation modeling explored the relationship between borderline personality features and self-harm. Results: Cronbach’s α was 0.71, indicating an “acceptable” level of reliability. Statistically significant correlations were observed between the presence of NSSI behavior and the total scores of SHI and PAI-BOR, and the four subscales of PAI-BOR. The frequency of NSSI showed statistically significant correlations with the total score of SHI and PAI-BOR, and its four subscales. Notably, 13.8% of participants reported engaging in self-harm behaviors, 26.9% reported a single occurrence, and 73.1% reported two or more instances. Structural equation modeling demonstrated that self-harm adequately predicted borderline personality traits. Conclusion This study successfully validated the adaptation of DSHI into K-NSSI. The K-NSSI can facilitate interventions for self-harm incidents.

Purpose: Although osimertinib is the standard-of-care treatment of epidermal growth factor receptor (EGFR) T790M mutation–positive non–small cell lung cancer, real-world evidence on the efficacy of osimertinib is not enough to reflect the complexity of the entire course of treatment. Herein, we report on the use of osimertinib in patients with EGFR T790M mutation–positive non–small cell lung cancer who had previously received EGFR tyrosine kinase inhibitor (TKI) treatment in Korea. Materials and Methods: Patients with confirmed EGFR T790M after disease progression of prior EGFR-TKI were enrolled and administered osimertinib 80 mg daily. The primary effectiveness outcome was progression-free survival, with time-to-treatment discontinuation, treatment and adverse effects leading to treatment discontinuation, and overall survival being the secondary endpoints. Results: A total of 558 individuals were enrolled, and 55.2% had investigator-assessed responses. The median progression-free survival was 14.2 months (95% confidence interval [CI], 13.0 to 16.4), and the median time-to-treatment discontinuation was 15.0 months (95% CI, 14.1 to 15.9). The median overall survival was 36.7 months (95% CI, 30.9 to not reached). The benefit with osimertinib was consistent regardless of the age, sex, smoking history, and primary EGFR mutation subtype. However, hepatic metastases at the time of diagnosis, the presence of plasma EGFR T790M, and the shorter duration of prior EGFR-TKI treatment were poor predictors of osimertinib treatment. Ten patients (1.8%), including three with pneumonitis, had to discontinue osimertinib due to severe adverse effects. Conclusion Osimertinib demonstrated its clinical effectiveness and survival benefit for EGFR T790M mutation–positive in Korean patients with no new safety signals.